2025 Volume 45 Issue 1 Pages 46-51
The patient was a 68-year-old woman who was undergoing chemotherapy for ovarian cancer following tumor debulking surgery, including from the bilateral diaphragmatic regions. She presented to our emergency department complaining of abdominal pain, chest pain, and breathlessness. CT examination confirmed gastric perforation and acute pleuroperitonitis due to left diaphragmatic hernia incarceration, and we undertook emergency surgical intervention. A 2-cm perforation was identified in the anterior wall of the upper gastric body, along with a 4-cm hernial defect in the left diaphragm. We performed local gastric resection, abdominal and pleural lavage and drainage, and diaphragmatic hernia repair. The patient was immunocompromised and had DIC with septic shock, but recovered well, was extubated on postoperative day 6, and was discharged home on postoperative day 24. We hypothesized that the diaphragmatic hernia in this case was because of the use of absorbable sutures for the primary repair or thermal injury of the diaphragm. The possibility of diaphragmatic hernia should be kept in mind during surgery involving the diaphragm and its surrounding area. If chemotherapy for malignant disease is planned for such patients, in view of the elevated risk of severe diaphragmatic hernia, repair or reinforcement with non-absorbable sutures should be undertaken during the surgery.
